Journal of Dental Sciences 17 (2022) 771e779

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Original Article

A retrospective study on the long-term

outcomes of pulpectomy and influencing
factors in primary teeth
Guili Dou, Dandan Wang, Sun Zhang, Wenli Ma, Mindi Xu,
Bin Xia*

Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National
Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering
Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital
Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry
of Health & NMPA Key Laboratory for Dental Materials, Beijing, China

Received 23 August 2021; Final revision received 28 September 2021

Available online 21 October 2021

KEYWORDS Abstract Background/purpose: Pulpectomy is the last means to preserve primary teeth with
Pulpectomy; pulpitis or pulp necrosis. The aim of the study was to investigate the survival rate of primary
Survival analysis; teeth after pulpectomies and to explore the factors influencing the prognosis of pulpectomy.
Tooth; Materials and methods: This retrospective study was performed on patients who received pri-
Deciduous mary tooth pulpectomy in the Department of Pediatric Dentistry at Peking University Hospital
of Stomatology between January 2014 and February 2019. The demographic characteristics of
children and the information of teeth treated were collected, and the clinical and radiographic
examination after treatment were evaluated. Survival analysis was performed to determine
the influencing factor of pulpectomy failure.
Results: A total of 592 primary anterior teeth and 583 primary molars were included. The 30-
month survival rate of primary anterior teeth was 58.5% and that of primary molars was 37.0%.
The survival rate of postoperative primary molars was lower than that of primary anterior
teeth (P < 0.05). Primary anterior tooth interventions with preoperative periapical lesions,
Vitapex
filling, or nongeneral anesthesia treatment had a higher failure risk (P < 0.05). Treat-
ment at an older age and glass ionomer cement filling indicated a higher failure risk for primary
molar pulpectomies.
Conclusion: Primary anterior teeth after pulpectomies had a higher survival rate than primary
molars. Periapical lesions, treatment methods, and root filling materials had significant

* Corresponding author. Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, No.22, Zhongguancun
South Avenue, Haidian District, Beijing, 100081, PR China.
E-mail address: xiabin@pkuss.bjmu.edu.cn (B. Xia).

https://doi.org/10.1016/j.jds.2021.10.007
1991-7902/ª 2021 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 G. Dou, D. Wang, S. Zhang et al.

impacts on the prognosis of primary anterior pulpectomies, and children’s age significantly
affected the prognosis of primary molar pulpectomies, which has not been reported before.
ª 2021 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier
B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.
org/licenses/by-nc-nd/4.0/).

Introduction pulpectomies in the Department of Pediatric Dentistry at

Peking University Hospital of Stomatology between January
Dental caries in primary teeth are a common chronic disease 2014 and February 2019. The inclusion criteria were as
worldwide, with a prevalence rate of up to 46.2%,1 espe- follows:
cially in developing countries. In China, the fourth national
oral epidemiological investigation showed that the preva- 1) Teeth treated because of irreversible pulpitis or pulp
lence of dental caries in children aged 5 years was 71.9% and necrosis, with or without periodontitis, for which
that the mean decayed-missing-filled teeth (dmft) index was radiographic examination showed no involvement of the
4.24,2 both of which were considerably higher than those 10 permanent successor and minimal or no root resorption.
years earlier (66.0%, dmft Z 3.5).3 Dental caries in the pri- 2) X-ray examination was performed before and after
mary dentition progress rapidly, often affecting the pulp treatment.
within a short duration. A requirement analysis of outpatient 3) Teeth from patients that underwent regular post-
treatment in a public dental hospital in China showed that operative examination with a follow-up time of no less
32.2% of children were diagnosed with pulp disease.4 The than 18 months.
American Association of Pediatric Dentistry (AAPD) recom-
mends pulpectomy as an elective treatment for periapical Teeth meeting the criteria below were excluded:
periodontitis in primary teeth and regards pulpectomy as a
final treatment to retain primary teeth with diffuse irre- 1) Teeth that have undergone trauma before treatment.
versible pulpitis or pulp necrosis.5 2) Teeth with abnormality.
Studies on primary tooth pulpectomies, mainly on filling 3) Children with systemic diseases that affect oral hygiene
materials,6e8 irrigants,9 and instrumentation methods,10,11 maintenance, such as autism.
have been published and reported success rates between 4) Teeth with incomplete medical records.
56% and 100%, with a follow-up time mostly no more than
18 months and small sample sizes. There are few studies on All pulpectomies were completed in compliance with the
the factors affecting the prognosis of deciduous tooth pul- AAPD guidelines and isolated with rubber dams.5 A six-
pectomies, and the conclusions have been inconsistent. month visit interval was recommended. Clinical and radio-
The difference in the success rate of pulpectomy in previ- graphic examinations were conducted during every follow-
ous studies and the inconsistent evaluation of influencing up.
factors on treatment have confused clinicians, and this is
not conducive to clinical treatment. Therefore, long-term
follow-up studies with large sample sizes are imperative. Data collection
A large number of primary teeth treated with pulpec-
tomies were evaluated in this study, with a follow-up time The following information from an electronic medical re-
of up to five years. This study aims to evaluate the long- cord system (Beijing Jiahe Meikang Information Technology,
term survival rate of pulpectomies in primary teeth and to Beijing, China) of Peking University Hospital of Stomatology
analyze the potential factors influencing their success. was collected:

1) Demographic characteristics, including gender, birth-

Materials and methods date, and systemic history.
2) Dental treatment information, including the history of
This retrospective study was conducted in accordance with trauma, the first visit date, rank of attending doctor
the tenets of the Declaration of Helsinki for research (intern or expert), tooth position (anterior or posterior),
involving human subjects, and approved by the Ethics treatment method (under general anesthesia (GA) or not
Committee of Peking University School and Hospital of [GA or non-GA]), periapical lesion (yes or no), clinical
Stomatology (approval number: PKUSSIRB-201949122). and radiographic manifestations, root filling material
Informed consent to use the records was obtained from (iodoform zinc oxide paste12 or Vitapex
[Neo-Dental,
the patients’ guardians. Tokyo, Japan]), and crown restoration material (resin
filling, preformed metal crown [PMC], or glass ionomer
Participants cement [GIC]).
3) Information obtained during follow-up, including
The study participants were selected among healthy chil- following visit dates, chief complaints, and clinical and
dren under 9 years old who received primary teeth radiographic examinations. If the tooth was already

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missing, the date of loss and the associated symptoms The survival rate of teeth after pulpectomy was determined
were recorded. using the KaplaneMeier method, and the log-rank test was
applied to compare the difference between survival rates.
Cox regression analysis was performed to estimate the
Clinical and radiological evaluation influencing factors of pulpectomy. Variables with P < 0.1 in
the univariate analysis were included in the multivariate
The pulpectomy was considered clinically successful in the analysis to be explored as possible risk factors. Factors
absence of pain, abnormal mobility, gingival pathology, and previously reported to influence success were also
severe crown restoration defects necessitating root canal included. The Wald test (Backward: Wald) method was
retreatment or extraction in relation to the tooth. If not, it used, and the significance level of the selected and
was labeled as a clinical failure. excluded variables was 0.05.
If the radiographic examination revealed a decrease in
size or disappearance of the initial periapical lesions within Results
6 months,5 with no new appearances of periapical lesions
and/or pathological root resorption, the treatment was
In total, 494 children (261 boys and 233 girls) and 1175
classified as a radiological success; otherwise, it was clas-
primary teeth were included in the study. The mean chro-
sified as a radiological failure.
nological age was 4.3 years, ranging from 1.4 to 8.5 years.
The interventional outcome was defined as overall failure The mean follow-up time was 998 days, ranging from 119 to
if the treatment exhibited clinical or radiological failure. In
1871 days.
addition, premature loss and delayed root resorption of
Among the 1175 primary teeth included, 592 were pri-
primary teeth after treatment were classified as failure,5
mary anterior teeth, and 583 were primary molars. There
and the natural loss of primary teeth with normal clinical
were 350 (59.1%) primary anterior teeth interventions and
and radiographic findings was classified as success. The pri-
220 (37.7%) primary posterior teeth interventions meeting
mary teeth were evaluated for premature loss or delayed
the success criteria. The median survival time for primary
root resorption by comparison with the contralateral teeth
anterior teeth was 1002 days and that for primary molars
and/or other adjacent teeth without pulp treatment. If
was 772 days. The survival rates of primary anterior teeth
there were no contralateral teeth or adjacent teeth without
and primary molars are listed in Table 1. Statistical analysis
pulp treatment, it was estimated based on the development showed that primary anterior teeth had a higher survival
stage of the permanent successor.
rate than primary molars (P < 0.001, Fig. 1). The primary
For primary teeth with failed pulpectomies, the date of
anterior teeth and primary molars were analyzed sepa-
failure was defined as enddate (T1), and the status of those rately in the following part because of their differences in
interventions was recorded as “failed”. If the primary tooth
the root canal morphology.
pulpectomies didn’t failed and were lost to follow-up, the
status of the treatment was recorded as “censored”, and the
final follow-up date was recorded as enddate (T2). The initial The follow-up results of primary anterior teeth
treatment date of the tooth was recorded as entdate (T0),
and the survival time (TS) was calculated as follow: For primary anterior teeth, 242 teeth interventions were
judged to have failed. Among them, 130 (53.7%) anterior
Ts Z T1 =T2 T0 teeth showed clinical failure and 203 (83.9%) anterior teeth
showed radiographic failure with 110 of them being clinical
All periapical films involved in this study were re- normal; 2 (0.8%) teeth showed delayed root absorption.
examined. Radiographic examinations were independently Two hundred and five teeth had X-rays at the moment of
performed by two pediatric dentists. Reevaluations were failure, 61 of them with succedaneous permanent tooth
done to reach consensus when the decisions of the exam- germ affected by primary teeth periapical periodontitis.
iners were conflict. Cohen’s kappa statistic showed excel- The basic characteristics of the primary anterior teeth are
lent reproducibility between the two investigators, with a presented in Table 2.
measurement agreement of 0.85 and intraexaminer reli- In the univariate analysis (Table 2), the survival rate of
ability (over two weeks) of 0.87. primary anterior teeth treated by experts was significantly
higher than that of teeth treated by interns. The recur-
Statistical analysis rence rate of primary anterior teeth with periapical lesions
was higher than that of teeth without periapical lesions
Statistical analyses were conducted using SPSS version 20.0 (P < 0.001). The anterior teeth treated under GA had a
(SPSS Inc., Chicago, IL, USA). Univariate analysis of cate- higher survival rate than teeth treated not under GA
gorical variables was performed using the chi-square test. (P Z 0.001), and teeth filled with iodoform zinc oxide paste

Table 1 The survival rate of primary anterior teeth and primary molars after pulpectomies.
Tooth position 6 months 12 months 18 months 24 months 30 months 36 months
Primary anterior teeth 97.4% 90.9% 83.0% 72.1% 58.5% 43.7%
Primary molars 97.0% 87.3% 76.0% 57.1% 37.0% 22.7%

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Figure 1 The survival curves of primary anterior teeth and primary molars after pulpectomy

Ninety-three successfully treated anterior teeth and 120

Table 2 Basic information of primary anterior teeth and failed treated anterior teeth had filling defects. The inci-
univariate analysis results. dence of filling body defects in the failed teeth was
Factors Censored Failed P* significantly higher than that in the successful teeth, and
Age (year) 350 242 0.078 the chi-square test showed that the difference was statis-
Gender Boy 191 128 0.278 tically significant (Table 3).
Girl 160 113 For primary anterior teeth, the failure risk of pulpec-
Attending doctors Intern 25 40 0.002 tomies with GA was significantly lower than that of pul-
Expert 326 201 pectomies with no GA. Treatments of teeth with periapical
Treatment method GA 278 150 0.001 lesions and Vitapex
filling were more likely to fail
Non-GA 73 91 (P < 0.05) (Table 4).
Periapical lesion No 278 154 0.000
Yes 73 87 The follow-up results of primary molars
Root canal Iodoform zinc 245 138 0.015
filling materials oxide paste Of the 363 primary molars classified as failed (Fig. 2),
Vitapex
106 103 91 molars showed clinical failure, 353 molars suffered
Crown restoration Resin filling 338 243 -a radiographic failure, and 1 tooth exhibited premature loss.
materials GIC filling 8 3 The clinical and imaging findings of 271 primary molars
*Analyzed by Cox regression analysis, and the bold P value
were inconsistent, with normal clinical manifestations but
indicated that the difference was significant (P < 0.05). abnormal radiographic examination. Of the 353 unsuccess-
GA, general anesthesia; GIC, glass ionomer cement; non-GA, ful primary molar interventions with postoperative X-rays,
non-general anesthesia. 165 (46.7%) succedaneous permanent tooth germs were
a
The difference in sample size between the two groups was affected by periapical inflammation of the primary teeth.
large, and no statistical test was conducted. Basic information on the primary molars is presented in
Table 5.
The univariate survival analysis (Table 5) showed that
had a higher survival rate than those filled with Vitapex
age had a significant impact on the failure risk of primary
(P Z 0.015) (Table 2). molars after pulpectomy (P < 0.001). A further analysis
Among the primary anterior teeth, 213 had crown resto- showed that the survival rate of primary molars of 2-year-
ration defects. The crown restoration defects can be divided old children was significantly higher than that of other age
into two categories: (i) severe restoration defect: the filling groups, and the survival rate of primary molars of over 7-
body/PMC of the teeth completely fell off, causing the year-old children was lower than that of other age groups
orifice exposed in the oral cavity; (ii) non-severe restoration (Fig. 3). Treatment under GA had a significantly lower
defect: secondary caries, filling body fractures etc. in which failure risk than that not under GA (P Z 0.010). The crown
the orifice was still covered by the basing materials with or restoration material had a significant impact on the prog-
without imperfect filling body above. nosis of molar pulpectomies (P Z 0.001), and the

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Table 3 Basic information of the crown fillings of primary anterior teeth after pulpectomies.
Primary anterior teeth With restoration defect Without c2 P*
restoration
defect
Severe restoration Non-severe Total (N/%) (N/%)
defect (N) restoration defect (N)
Successful 0 93 93 (26.6%) 257(73.4%) 32.902 0.000
Failed 52 68 120 (49.6%) 122(50.4%)
*Analyzed by chi-square test, and the bold P value indicated that the difference was significant (P < 0.05).

Table 4 Results of multivariate Cox regression analysis of primary anterior teeth after pulpectomy
Co-variable Subgroup B P* HR 95% CI for HR
Lower Upper
Age 0.027 0.725 1.027 0.885 1.192
Attending doctors Intern 0 1
Expert 0.157 0.471 0.855 0.557 1.310
Treatment method Non-GA 0 1
GA 0.329 0.021 0.719 0.544 0.952
Periapical lesion No 0 1
Yes 0.353 0.014 1.424 1.073 1.889
Root canal filling material Iodoform zinc oxide paste 0 1
Vitapex
0.322 0.015 1.380 1.064 1.790
*The bold P value indicated that the difference was significant (P < 0.05).
B, coefficient of regression; CI, confidence interval; GA, general anesthesia; HR, hazard ratio; non-GA, non-general anesthesia.

recurrence rate of teeth with resin filling was lower than teeth.15,16 This distinction is speculated to be caused by
that with GIC filling. morphological differences in primary teeth. Most primary
Among the 583 primary molars, 88 molars had crown anterior teeth have a single canal and few lateral branches
restoration defects during follow-up, including 20 severe or root tip bifurcations,17 but different forms of the
restoration defects and 68 non-severe restoration defects. accessory root canal are common in primary molars. Mor-
The classification of restoration defects was consistent with abito et al. observed 30 primary molars using a scanning
primary anterior teeth. The incidence of restoration defect electron microscope and found that 21 of them had
between the molars survived after pulpectomy and the accessory canals at the bottom of the pulp chamber, in
molars failed after pulpectomy showed no significant dif- which pulp tissue and necrotic tissue were observed.18 The
ference (P > 0.05) (Table 6). complex structure of the root canal is not conducive to the
The multivariate analysis results of the Cox regression removal of infection, and the remaining bacteria lead to
showed that age and crown restoration material had a pulpectomy failure.19 Therefore, primary anterior and
statistically significant impact on the failure risk of primary posterior teeth were analyzed independently in this study.
molar pulpectomies (Table 7). The failure risk of treatment Pulpectomies of primary anterior teeth with periapical
increased with age, and the hazard ratio (HR) was 1.185 lesions were more likely to fail than those of teeth without
(95% CI, 1.082e1.297) (P < 0.001). Interventions with GIC periapical lesions. It is difficult to remove all the patho-
restorations were more likely to fail than those with resin genic bacteria in the periapical tissue through chemo-
filling (P < 0.05). mechanical preparation, and the residual bacteria can in-
crease the postoperative failure risk.20 Chen et al. also
reported worse prognosis of pulpectomy in primary teeth
Discussion with periapical lesions.16 However, interventions in primary
molars with periapical lesions had a similar survival rate to
This study had a much larger sample size than previous teeth without periapical lesions. As mentioned before, the
studies on pulpectomy,13,14 with a mean follow-up time of canal system of primary molars is more complicated than
33 months and longest follow-up time of 62 months. The that of primary anterior teeth, and it is speculated that
survival rate of primary anterior teeth at 24 months after there is more residual infection in the primary molar canal
pulpectomy was 72.1%, higher than 57.1% of primary mo- system after root canal preparation than in the root canals
lars. Studies have reported different success rates of pul- of anterior teeth, which can also cause occurrence of
pectomies between primary anterior teeth and primary periapical periodontitis.
molars, but the difference was not statistically significant In anterior teeth, pulpectomies with non-GA had a lower
due to the small sample size, especially in anterior survival rate than those with GA. Children who need

775
 G. Dou, D. Wang, S. Zhang et al.

Figure 2 The right mandibular first primary molar and second primary molar were treated with pulpectomies due to pulpitis
caused by caries. a: The radiograph before treatment revealed no periapical radiolucency. b: The immediate postoperative
radiograph showed adequate filling in distal root canals and slight underfilling in mesial root canals. c: Twelve months after pul-
pectomy, radiolucency was seen around the distal root of the first mandibular primary molar. d: Thirty-five months after pul-
pectomy, the area of radiolucency around the distal root of the first mandibular primary molar became larger, and the second
primary molar also showed a periapical lesion around the mesial root. All the pulpectomies failed.

pulpectomies of deciduous anterior teeth are young and absorb after being overcharged,23 and the material in the
always have poor cooperation. When treated under general root canal is absorbed faster than the root, resulting in
anesthesia, the root canal can be prepared and disinfected emptiness in the root canal,24,25 which may be one of the
more thoroughly without being affected by poor coopera- reasons for the failure.
tion of children. Meanwhile, resin restoration, which is For primary molars, we found that treatment at older
sensitive to the technique and humidity, could be carried ages was more likely to fail than that at a younger age, and
out with good moisture control. It was reported that the the difference was statistically significant. This finding has
time of secondary caries on teeth treated under GA was not been reported previously. According to previous studies
significantly later than that in the non-GA group.21 In this on permanent teeth,26e28 root canal morphology changes
study, the percentage of filling defects in the GA group was with age, and secondary dentin deposition may change the
31.8%, which was lower than that in the non-GA group root canal diameter or lead to severe canal calcification,
(47.0%). The occurrence of filling defect was related to the increasing the difficulty of root canal preparation. In pri-
failure of treatment (Table 3). mary molars, similar age-related changes were also re-
Vitapex and iodoform zinc oxide pastes are commonly ported by Amano et al., indicating that the volume ratio
used root filling pastes.22 Some studies have shown that the between the pulp chamber and the crown is larger in the
success rate of iodoform zinc oxide paste pulpectomy is primary dentition than in the mixed dentition.29 The reason
higher than that of Vitapex after treatment.13 However, why the success rate of pulpectomy was affected by age
other studies have shown different results.6,23 In this study, may be related to changes in root canal anatomy with age.
treatment with Vitapex filling had a higher failure risk than Ahmed suggested that it is necessary to study the rela-
that with zinc oxide iodoform paste. Vitapex is easy to tionship between canal morphology and pulpectomy

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 Journal of Dental Sciences 17 (2022) 771e779

which was higher than that of PMC (2.3%) and resin filling
Table 5 Basic information of primary molars after pul-
(27.7%). Fine crown restoration can prevent micro leakage
pectomy and univariate analysis results.
and has an impact on the prognosis of pulpectomy.31 After
Factors Censored Failed P* pulpectomy, clinicians should attach importance to crown
Age (year) 220 363 0.000 repair and carry out permanent restoration as soon as
Gender Boy 124 183 0.185 possible. Although the survival rate of PMC was higher than
Girl 96 180 that of resin filling in terms of restoration materials,32 the
Attending doctors Intern 63 98 0.135 prognosis of pulpectomy restored by PMC and resin com-
Exporter 157 265 posite showed no significant differences, considering the
Treatment method GA 109 188 0.010 apical periodontal health was used as the outcome in this
Non-GA 111 175 study. A similar result was reported by Moskovitz.33 The
Periapical lesion No 157 258 0.546 failure rate of pulpectomies with PMC and resin filling (RF)
Yes 63 105 was 62.0% and 61.7% respectively, which were much higher
Root filling materials iodoform zinc 192 295 0.951 than the incidence of crown restoration defect of PMC and
oxide paste RF mentioned above. This is because the recurrence of
Vitapex 28 68 periapical periodontitis after root canal therapy is not only
Crown restoration Resin filling 90 145 0.001 affected by crown restoration, but also affected by other
material GIC filling 13 27 factors such as case selection, evaluation criteria, etc.
PMC 117 191 There are some limitations to this study. First, the
inconsistency between radiographic and clinical manifes-
*Analyzed by Cox regression analysis, and the bold P value
tations makes it difficult to detect periapical diseases on
indicated that the difference was significant (P < 0.05).
GA, general anesthesia; GIC, glass ionomer cement; non-GA, time. Regular radiographic examination is recommended
non-general anesthesia; PMC, preformed metal crown. for primary teeth after pulpectomy to find the periapical
lesion in time. However, in children, the potential radiation
damage caused by multiple radiographic evaluations should
failure.30 The discovery of the influencing factor of age is be carefully considered to determine the risk-benefit ratio.
beneficial to predict the prognosis of pulpectomy before Second, this is a retrospective study based on existing case
treatment, reminding doctors to pay special attention to records, in which there may be a recording inaccuracy. To
checking the molar pulpectomies of older children. avoid false records, we also checked all of the X-ray films
In this study, the crown of primary molars was restored when the records were examined.
by resin filling, GIC filling and PMC. The results revealed The survival rate of primary molars was much lower than
that the failure risk of primary molar pulpectomies with GIC that of primary anterior teeth. The presence of periapical
filling was higher than that of resin filing, and the differ- lesions for anterior teeth and children’s age for primary
ence between resin filling and PMC was not significant in molars can be predictors for the prognosis of pulpectomy.
the multivariate analysis. The teeth after GIC filling were For primary anterior teeth, treatment under GA and with
prone to filling defects, with an incidence rate of 40.0%, iodoform zinc oxide paste filling had a lower failure risk.

Figure 3 Survival curves of primary molars from children in different age groups after treatment.

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 G. Dou, D. Wang, S. Zhang et al.

Table 6 Basic information of the crown restorations of primary molars after pulpectomies.
Primary molars With restoration defect Without restoration c2 Pa
Severe restoration Non-severe restoration Total (N/%) defect (N/%)
defect (N) defect (N)
RF GIC PMC RF GIC PMC
Successful 0 0 0 26 8 3 37(16.8%) 183(83.2%) 0.819 0.365
Failed 15 3 2 24 5 2 51(14.0%) 312(86.0%)
GIC, glass ionomer cement filling; PMC, preformed metal crown; RF, resin filling.
a
Analyzed by chi-square test.

Table 7 Results of multivariate Cox regression analysis of primary teeth after pulpectomy
Co-variable Subgroup B P* HR 95% CI for HR
Lower Upper
Age e 0.169 0.000 1.185 1.082 1.297
Attending doctors Intern 0 1
Exporter 0.041 0.762 0.960 0.737 1.251
Treatment method Non-GA 0 1
GA 0.015 0.936 0.985 0.682 1.422
Periapical lesion No 0 1
Yes 0.095 0.439 0.910 0.715 1.157
Root filling materials Iodoform zinc oxide paste 0 1
Vitapex 0.063 0.651 1.065 0.811 1.397
Restoration materials Resin filling 0 1
GIC filling 0.414 0.049 1.513 1.002 2.285
PMC 0.138 0.231 0.871 0.695 1.092
*The bold P value indicated that the difference was significant (P < 0.05).
B, coefficient of regression; CI, confidence interval; GA, general anesthesia; GIC, glass ionomer cement; HR, hazard ratio; non-GA, non-
general anesthesia; PMC, preformed metal crown.

Declaration of competing interest 4. Xia B, Qin M, Han Y, Zhang S. Children stomatology outpatient
treatment requirements analysis and countermeasures. J
Peking Univ (Heal Sci) 2013;45:92e6 [In Chinese, English
The authors have no conflicts of interest relevant to this abstract].
article. 5. AAPD Council On Clinical Affairs. Pulp therapy for primary and
immature permanent teeth. Pediatr Dent 2018;40:343e51.
6. Pramila R, Muthu MS, Deepa G, Farzan JM, Rodrigues SJ. Pul-
Acknowledgements pectomies in primary mandibular molars: a comparison of
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7. Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation
Hospital, for help with the statistical analyses and the
of 3Mix and Vitapex as treatment options for pulpally involved
American Journal Experts editing team for their language
primary molars. Int J Paediatr Dent 2010;20:214e21.
editing services. This project was supported by grant Cap- 8. Trairatvorakul C, Chunlasikaiwan S. Success of pulpectomy
ital’s Funds for Health Improvement and Research (Grant with zinc oxide-eugenol vs calcium hydroxide/iodoform paste
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303e8.
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